Diagnosis

To diagnose de Quervain's tenosynovitis, your doctor will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist.

Your doctor will also perform a Finkelstein test, in which you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, you likely have de Quervain's tenosynovitis.

Imaging tests, such as X-rays, generally aren't needed to diagnose de Quervain's tenosynovitis.

Treatment

Treatment for de Quervain's tenosynovitis is aimed at reducing inflammation, preserving movement in the thumb and preventing recurrence.

If you start treatment early, your symptoms should improve within four to six weeks. If your de Quervain's tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breast-feeding.

Medications

To reduce pain and swelling, your doctor may recommend using over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).

Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. If treatment begins within the first six months of symptoms, most people recover completely after receiving corticosteroid injections, often after just one injection.

Therapy

Initial treatment of de Quervain's tenosynovitis may include:

  • Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons
  • Avoiding repetitive thumb movements as much as possible
  • Avoiding pinching with your thumb when moving your wrist from side to side
  • Applying ice to the affected area

You may also see a physical or occupational therapist. These therapists may review how you use your wrist and give suggestions on how to make adjustments to relieve stress on your wrists. Your therapist can also teach you exercises for your wrist, hand and arm to strengthen your muscles, reduce pain and limit tendon irritation.

Surgery

If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release the pressure so your tendons can glide freely.

Your doctor will talk to you about how to rest, strengthen and rehabilitate your body after surgery. A physical or occupational therapist may meet with you after surgery to teach you new strengthening exercises and help you adjust your daily routine to prevent future problems.

Lifestyle and home remedies

If you don't need surgery, caring for your condition is much the same as preventing it:

  • Avoid moving your wrists the same way repeatedly.
  • Wear a brace or splint if suggested by your doctor.
  • Follow through with recommended exercises.
  • Note activity that causes pain, swelling or numbness in your thumb and wrist, try to avoid it, and share that information with your doctor.

Preparing for your appointment

Make an appointment with your doctor if you have hand- or wrist-related pain and self-care measures — such as avoiding activities that trigger your pain — aren't helping. After an initial exam, your doctor may refer you to an orthopedist, rheumatologist, hand therapist or occupational therapist.

Here's some information to help you get ready for your appointment.

What you can do

  • Write down key medical information, including other conditions you have and all medications and supplements you're taking.
  • Note hobbies and activities that may strain your hand or wrist, such as knitting, gardening, playing an instrument, participating in racket sports or performing repetitive workplace activities.
  • Note any recent injuries to your hand or wrist.
  • Write down questions to ask your doctor.

Below are some basic questions to ask a doctor who evaluates you for wrist- or hand-related symptoms.

  • What is the most likely cause of my symptoms?
  • Are there other possible causes?
  • Do I need tests to confirm the diagnosis?
  • What treatment do you recommend?
  • I have other health problems. How can I best manage these conditions together?
  • Will I need surgery?
  • How long will I need to avoid the activities that caused my condition?
  • What else can I do on my own to improve my condition?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • What are your symptoms and when did they begin?
  • Have your symptoms been getting worse or staying the same?
  • What activities seem to trigger your symptoms?
  • Do you participate in any hobbies or sports that involve repetitive hand or wrist movements?
  • What tasks do you perform at work?
  • Have you recently had an injury that may have damaged your hand or wrist?
  • Does it help to avoid the activities that trigger your symptoms?
  • Have you tried at-home treatments, such as over-the-counter pain relievers? What, if anything, helps?
June 13, 2015
References
  1. De Quervain's tendinitis (De Quervain's tendinosis). American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00007. Accessed April 30, 2015.
  2. Anderson BC, et al. de Quervain's tenosynovitis. http://www.uptodate.com/home. Accessed April 30, 2015.
  3. de Quervain syndrome. American Society for Surgery of the Hand. http://www.assh.org/handcare/hand-arm-conditions/de-quervain-syndrome. Accessed April 30, 2015.
  4. Peters-Veluthamaningal C, et al. Corticosteroid injection for de Quervain's tenosynovitis. Cochrane Database of Systematic Reviews. http://ovidsp.tx.ovid.com/sp-3.15.1b/ovidweb.cgi?&S=MDMIFPOGBPDDNLCMNCKKHEMCBFIFAA00&Link+Set=S.sh.18|1|sl_50. April 30, 2015.
  5. Goel R, et al. de Quervain’s tenosynovitis: a review of the rehabilitative options. Hand. 2015;10:1.

De Quervain's tenosynovitis